Cedarbrae Community Centre Membership Form & Waiver

CEDARBRAE COMMUNITY LEAGUE ASSOCIATION MEMBERSHIP APPLICATION

May 1, 2022 to April 30, 2023
All Cedarbrae Community League Association memberships expire on April 30th of each year. Please provide your current household information to renew / apply for a membership.
Street Address *
City *
Province *
Postal Code *
Have you previously held a membership with the Cedarbrae Community League Association? *

Yes No
Please choose the appropriate membership category. For households with more than two adults over the age of 18 an individual membership fee will be billed for each additional member.
Membership Category? *

$15.00 - Individual Membership (1 person in household) $30.00 - Family Membership (2 persons plus children under 18 living at the same household) $15.00 - Senior Household Membership (Max 2 persons over 55 living at the same household)
Do you have any children in the home under 18 years old?

Yes No

Waiver and Release of Liability

In consideration of being allowed to participate in any way with Drop-In Activities, Athletic orSports Programming, Other Physical Events and Cedarbrae Community League Association (CCLA) activities, the undersigned acknowledges, appreciates, and agrees that:
Participation includes possible exposure to and illness from Covid-19. While guidelines and rules implemented may reduce this risk, the risk of serious illness and death does exist and CCLA cannot prevent you from becoming exposed to, contracting, or spreading Covid-19 while utilizing The Cedarbrae League Community Association’s services or premises. It is impossible to prevent the disease therefore if you choose to participate in any activities at The Cedarbrae League Community Association you may be exposing yourself to Covid-19 and increasing your risk of contracting and spreading Covid- 19 *

Clear
The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, *

Clear
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, *

Clear
I willingly agree to comply with the stated and customary terms and conditions for participation in regard to protection against Covid-19. IF, however, I observe any unusual significant hazard during participation. I will bring it to the attention of the nearest CCLA employee or official immediately and, *

Clear
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS CCLA, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (“Releases”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. *

Clear
WAIVER / MEDIA CONSENT: I hereby authorize images or video footage taken of myself, in whole or in part, individually or in conjunction with other images and video footage, to be displayed on the CCLA Website and other official channels, and to be used for media purposes including promotional presentations and marketing campaigns. I waive rights to privacy and compensation, which I may have in connection with such use of my name and likeness, including rights to be written copy that may be created in connection with video production, editing and promotion therewith.

Clear

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
First & Last Name *
Signature *

Clear
Emergency Contact
Emergency Contact's Name *
Emergency Contact's Phone Number
Please enter a valid phone number.
Relationship to Emergency Contact *
Should be Empty:

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CEDARBRAE COMMUNITY LEAGUE ASSOCIATION MEMBERSHIP APPLICATION

Household Member Information

Pickleball Program Access

Waiver and Release of Liability

Emergency Contact